To the Editor: We read with interest the study conducted by Paul G. Surtees, Ph.D., et al., published in the April 2008 issue of the Journal(1). The authors reported that major depression was associated with increased heart disease mortality in nearly 20,000 individuals between the ages of 41 and 80 years who participated in the Norfolk, U.K. cohort of the European Prospective Investigation Into Cancer (EPIC-Norfolk) Study. This finding suggests that depression specifically increases cardiovascular mortality by cardiovascular mechanisms.
However, Dr. Surtees et al. did not report the association between depression and noncardiovascular mortality. Earlier findings from the EPIC-Norfolk study showed that both cardiovascular and noncardiovascular mortality are increased among individuals with poor self-reported mental health (2) and poor sense of coherence (3). When noncardiovascular mortality is also increased among depressed individuals, it is likely that unhealthy behavior and a lifestyle inherent to depression, rather than cardiovascular mechanisms, explain the increased mortality risk associated with depression (4).
The authors report no competing interests.
This letter (doi: 10.1176/appi.ajp.2008.08040523) was accepted for publication in May 2008.